Re: APPROVED by BLUE CROSS of CALIFORNIA !!!!

[Guest guest]

Shirley, that is fantastic! Congrats Congrats

Congrats!

dee

who doesn't even have BC but is thrilled!

--- Shirley Groom wrote:

> Hey everybody!!!! No kidding!!! I've been

> approved for a Duodenal Switch procedure. Yes, by

> Blue Cross of California PPO!

__________________________________________________

[Guest guest]

ShirleyAnn,

I am sooooooooo thrilled for you! Congratulations! You are on your

way lady!

Hugs,

Theresa

> Hey everybody!!!! No kidding!!! I've been approved for a

Duodenal Switch procedure. Yes, by Blue Cross of California PPO !!!!!

>

> I didn't even do an appeal. I just bugged the heck out of people

and finally the nurse assigned to my case (Nurse Kathy) sent it for

RECONSIDERATION by an " outside " doc.

>

> Dr. Welker called me yesterday and told me the good news, but

suggested I hold off spreading the word until I heard directly from

Blue Cross. He said he'd talked with a Dr. Blickenstaff. The doc

said something like " Oh, no. Not the DS again. I've discussed this

a hundred times. " Dr. Welker said something like " There must be

something you'd like to know that would convince you about the

effectiveness of the DS... " He went on and finally did convince Dr.

Blickenstaff and Dr. B said he'd approve it. Dr. Welker is a god!!!

>

> Nurse Kathy just called today (she had yesterday off) and asked if

I was sitting down. Then she told me the good news. (I didn't let

on that my surgeon had called me yesterday.) She was very excited

for me!

>

> Can you believe it? I cried when Dr. Welker called (and I'm not an

overly emotional person). Will I really be a normal weight person

for the FIRST TIME in my life? When I say that is unbelievable, I'm

being very serious.

>

> Oh, my God. Now I have to schedule a date. The nurse is putting

Dec. 20 down as a date...although I told her I can't do it 'till

January. I'm to get back to her when I decide on the date.

>

> Oh, my God. Oh, oh, oh, oh.... I'm still in a daze. I didn't

think I would ever be approved.

>

> ~~ShirleyAnn

> Pre-op Dr. Welker

>

>

>

[Guest guest]

Shirley Ann,

Definitely good news. I bet being persistant finally paid off!

Warmly,

[Guest guest]

Shirley,

That's soo great! i'm going through the same problem with them saying

they will not approve DS only RNY in Blue Cross (Comunity Choice PPO) in

ohio. Any hints on what you did? and/or who you contated? i've been told i

might be put through a grueling appeal process that would not get me

anywhere (this is from the doctor that i've been considering for DS, they

say they have tried it many times before).

I have also been told that with BC/BS you adopt the rules of the state which

the procedure would be done in... This was from the Images program in Texas

which does the RNY procedure... in there case they would NOT cover the

procedure because BC/BS of texas only paid something like 5-8k max for the

surgery. But i didn't know if maybe this works in reverse for states that

accept DS as a viable form...

anyways, ANY help would be sooooo much appreciated...

-

>

>Hey everybody!!!! No kidding!!! I've been approved for a Duodenal Switch

>procedure. Yes, by Blue Cross of California PPO !!!!!

>

>I didn't even do an appeal. I just bugged the heck out of people and

>finally the nurse assigned to my case (Nurse Kathy) sent it for

>RECONSIDERATION by an " outside " doc.

>

>Dr. Welker called me yesterday and told me the good news, but suggested I

>hold off spreading the word until I heard directly from Blue Cross. He

>said he'd talked with a Dr. Blickenstaff. The doc said something like " Oh,

>no. Not the DS again. I've discussed this a hundred times. " Dr. Welker

>said something like " There must be something you'd like to know that would

>convince you about the effectiveness of the DS... " He went on and finally

>did convince Dr. Blickenstaff and Dr. B said he'd approve it. Dr. Welker

>is a god!!!

>

>Nurse Kathy just called today (she had yesterday off) and asked if I was

>sitting down. Then she told me the good news. (I didn't let on that my

>surgeon had called me yesterday.) She was very excited for me!

>

>Can you believe it? I cried when Dr. Welker called (and I'm not an overly

>emotional person). Will I really be a normal weight person for the FIRST

>TIME in my life? When I say that is unbelievable, I'm being very serious.

>

>Oh, my God. Now I have to schedule a date. The nurse is putting Dec. 20

>down as a date...although I told her I can't do it 'till January. I'm to

>get back to her when I decide on the date.

>

>Oh, my God. Oh, oh, oh, oh.... I'm still in a daze. I didn't think I

>would ever be approved.

>

>~~ShirleyAnn

>Pre-op Dr. Welker

>

>

>

[Guest guest]

Hi All,

I'm new here and in the learning stages of having the DS surgery done.

I am so excited to hear about Shirley Ann's approval! (Congratulations,

Shirley Ann! I am sure you are walking on clouds!)

I have already been told by BC, CA PPO that they don't approve these

procedures, but now I have ammunition! My friend, too, was told he wouldn't

get approval, but we will bombard the insurance company until they approve!

Onward!

I have received all the paperwork from Dr. Rabkin and am quite

intimidated by the financial outlay. I have been disabled for a long time by

degenerative spinal disease. Dr. Bradford told me last month that if I don't

have two spinal surgeries I will be paralyzed - - but I have to lose massive

amounts of weight first. We don't have the income to pay the price without

the insurance coverage. My worry now is those dreaded words, " reasonable and

customary. "

Does anyone know what the out-of-pocket outlay was for BC of CA PPO

with coverage? I know they pay 80% of " reasonable and customary " but if they

decide " reasonable and customary " is 80% of $5,000 - - I'll never be able to

afford the surgery!

You all seem like the greatest bunch! The friendliness and

camaraderie are very welcoming. Thank you. Ann in CA

[Guest guest]

Congratulations!

Gil

Dr. Keshishian

11/8 - 264 lbs

11/26 - 240 lbs

> Hey everybody!!!! No kidding!!! I've been approved for a

Duodenal Switch procedure. Yes, by Blue Cross of California PPO !!!!!

>

> I didn't even do an appeal. I just bugged the heck out of people

and finally the nurse assigned to my case (Nurse Kathy) sent it for

RECONSIDERATION by an " outside " doc.

>

> Dr. Welker called me yesterday and told me the good news, but

suggested I hold off spreading the word until I heard directly from

Blue Cross. He said he'd talked with a Dr. Blickenstaff. The doc

said something like " Oh, no. Not the DS again. I've discussed this

a hundred times. " Dr. Welker said something like " There must be

something you'd like to know that would convince you about the

effectiveness of the DS... " He went on and finally did convince Dr.

Blickenstaff and Dr. B said he'd approve it. Dr. Welker is a god!!!

>

> Nurse Kathy just called today (she had yesterday off) and asked if

I was sitting down. Then she told me the good news. (I didn't let

on that my surgeon had called me yesterday.) She was very excited

for me!

>

> Can you believe it? I cried when Dr. Welker called (and I'm not an

overly emotional person). Will I really be a normal weight person

for the FIRST TIME in my life? When I say that is unbelievable, I'm

being very serious.

>

> Oh, my God. Now I have to schedule a date. The nurse is putting

Dec. 20 down as a date...although I told her I can't do it 'till

January. I'm to get back to her when I decide on the date.

>

> Oh, my God. Oh, oh, oh, oh.... I'm still in a daze. I didn't

think I would ever be approved.

>

> ~~ShirleyAnn

> Pre-op Dr. Welker

>

>

>

[Guest guest]

Hi Ann:

I can't remember all the details...but this was my understanding of

how Dr. Rabkin's office works. You pay $12K up front to secure a

surgery date, this is his fee (includes the program fee). He then

submits your paperwork to the insurance company, and if you get

approval, you get back whatever the insurance co. would normally pay

the doctor. So, for example if the UCR is only $8000, then you're

still out the $5000 from the initial $12K you had to put out to

secure a surgery date.

Hope this helps. I'm sure people on the Rabkin board could give you

more details. When speaking with his office, be sure to ask about

this. I had a consult with him back in July, and no one there

mentioned this to me. I found it out through this group. If Dr.

Rabkin doesn't work out for you, you may want to consider another

doctor. I went to Dr. Keshishian in Delano. He is in-network for me

and he also accepts whatever the insurance company pays. He also has

a really terrific bedside manner.

Regards,

Gil

Dr. Keshishian

11/8 - 264 lbs

11/26 - 240 lbs

> Hi All,

> I'm new here and in the learning stages of having the DS

surgery done.

> I am so excited to hear about Shirley Ann's approval!

(Congratulations,

> Shirley Ann! I am sure you are walking on clouds!)

> I have already been told by BC, CA PPO that they don't

approve these

> procedures, but now I have ammunition! My friend, too, was told he

wouldn't

> get approval, but we will bombard the insurance company until they

approve!

> Onward!

> I have received all the paperwork from Dr. Rabkin and am

quite

> intimidated by the financial outlay. I have been disabled for a

long time by

> degenerative spinal disease. Dr. Bradford told me last month that

if I don't

> have two spinal surgeries I will be paralyzed - - but I have to

lose massive

> amounts of weight first. We don't have the income to pay the price

without

> the insurance coverage. My worry now is those dreaded

words, " reasonable and

> customary. "

> Does anyone know what the out-of-pocket outlay was for BC of

CA PPO

> with coverage? I know they pay 80% of " reasonable and customary "

but if they

> decide " reasonable and customary " is 80% of $5,000 - - I'll never

be able to

> afford the surgery!

> You all seem like the greatest bunch! The friendliness and

> camaraderie are very welcoming. Thank you. Ann in CA

>

>

>